Provider Demographics
NPI:1134724487
Name:CENTER FOR AGING AND REHABILITATION OF GULF COUNTY INC
Entity type:Organization
Organization Name:CENTER FOR AGING AND REHABILITATION OF GULF COUNTY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:BROCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-367-4597
Mailing Address - Street 1:100 SE 2ND ST STE 2000
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-2101
Mailing Address - Country:US
Mailing Address - Phone:954-367-4597
Mailing Address - Fax:954-367-4564
Practice Address - Street 1:220 9TH ST
Practice Address - Street 2:
Practice Address - City:PORT ST JOE
Practice Address - State:FL
Practice Address - Zip Code:32456-1924
Practice Address - Country:US
Practice Address - Phone:850-229-8244
Practice Address - Fax:850-229-1042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-03
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility